Fractional carbon dioxide vaginal laser for the treatment of urinary symptoms: 36-month results
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Published on: July 6, 2022
Bernadette M M Zwaans1,2, Larry T Sirls1,2, Annah Vollstedt1
1Corewell Health William Beaumont University Hospital, 3535 West 13-Mile Road, Suite 438, Royal Oak, MI, 48073, USA.
Purpose:
Fractional carbon dioxide laser (fCO2) has been proposed to treat vulvo-vaginal symptoms of genitourinary syndrome of menopause (GSM), and urinary symptoms including urgency, urgency urinary incontinence (UUI), and stress urinary incontinence (SUI). The thermal effects of the fCO2 laser can lead to collagen remodeling, improving vaginal tissue integrity and urethral support. Our study aimed to measure the impact of vaginal fCO2 laser therapy on a general group of women with vulvovaginal and urinary symptoms.
Methods:
Women with complaints of urogenital symptoms were enrolled in an open-label prospective trial. Participants underwent three laser treatments, each 6 weeks apart. Follow-up consisted of 6-, 12-, 24- and 36-month visits during which cough stress test was performed and questionnaires were administered. ANOVA analysis was used to compare means at each time point.
Results:
100 women, 73 menopausal, with an average age of 55 were enrolled in the study. The PGI-I at 16 weeks showed 32/80 (40.0%) patients were markedly or moderately better, 20/74 (27%) at 6 months, 22/60 (36.7%) at 1 year, 17/44 (38.6%) at 24 months and 17/38 (44.7%) at 36 months. Patients reported significant improvement on the QUID-UUI at all visits out to 36 months, but no significant decrease in UUI episodes was noted. Urinary frequency and OABq symptom and quality-of-life scores significantly improved at each follow-up visit. For those reporting SUI at baseline, SUI leaks were not altered, but QUID-SUI scores were significantly reduced at each follow-up visit compared to baseline (p < 0.0001). Significant reduction in the incidence of vulvar dryness (p = 0.0016) and vulvar burning (p = 0.0086) were seen.
Conclusion:
Our results show that vaginal fCO2 laser therapy improves vulvovaginal symptoms and urinary symptoms. The urge/OAB patients reported significant durable improvement to 36 months. PGI-I found 44.7% of women markedly or moderately better at 36 months. More research is needed for long-term results.
